---
kind: "section"
citation: "42 C.F.R. § 512.535"
title: "42"
number: "512.535"
heading: "Beneficiary inclusion criteria."
url: "https://uscodex.org/cfr/42/512.535"
---

# §512.535. Beneficiary inclusion criteria.

- (a) Episodes tested in TEAM include only those in which care is furnished to beneficiaries who meet all of the following criteria upon admission for an anchor procedure or anchor hospitalization:
  - (1) **Are enrolled in Medicare Parts A and B.**
  - (2) Are not eligible for Medicare on the basis of having end stage renal disease, as described in [§ 406.13](/cfr/42/406.13.md) of this chapter.
  - (3) Are not enrolled in any managed care plan (for example, Medicare Advantage, health care prepayment plans, or cost-based health maintenance organizations).
  - (4) **Are not covered under a United Mine Workers of America health care plan.**
  - (5) **Have Medicare as their primary payer.**
- (b) The episode is canceled in accordance with [§ 512.537(b)](/cfr/42/512.537.md?p=b) if at any time during the episode a beneficiary no longer meets all criteria in this section.

## Notes

### Source

Source: 89 FR 69914, Aug. 28, 2024, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302, 1315a, and 1395hh.

### Source

Source: 85 FR 61362, Sept. 29, 2020, unless otherwise noted.